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Making Healthcare Collaborative (ft. Tim Coan)

Madison Schwindenhammer Jan 11, 2021 6:02:09 AM

In this episode of Making Healthcare ‘Collaborative,’ Tim Coan talks about growing up in a small town, working hard at being bad at sports, the innate problems with the incentive structures in healthcare, and how ALN is helping independent physician groups to make a positive impact.

Tim Coan is the CEO at ALN Medical Management.

View the previous episode of Making Healthcare with Lisa Zimmers here.


DP: Healthcare is changing. And our goal for the making healthcare podcast is to capture and share the stories of innovators and disruptors who are shaping the future of healthcare. Today. They’re making healthcare safer, making healthcare affordable, making healthcare innovative. I’m David Park, CEO of VirtuSense Technologies and the host of Making Healthcare.

Today’s guest is Tim Coan, healthcare expert, and founder and CEO of ALN medical management, which provides training and ongoing support for physician practices. Tim has an office mate, an English bulldog named Moose, who is actually a professional napper. 

Tim is a romantic at heart. He actually met his wife at work.

And a third fun fact about him is he was encouraged by his son to shave his head for COVID. Welcome to Making Healthcare, Tim. 

TC: Thanks, Dave. Appreciate it. And look forward to being with you today. 

DP: Likewise, we’re very glad to have you with us. So, please introduce yourself to our listeners. 

TC: Yeah. My name is Tim Coan  and I live in Denver, Colorado. I have been fortunate enough, along with my partner, to be at ALN now for about 21 years. We service independent physician practices and, I am a recovering healthcare strategy guy at heart, which we may talk about a little bit. We are in the business of, … we’re plumbers. We’re in the revenue cycle business.  We process claims for independent physicians and get them paid. But in the process of that, because we deal with the financial issues around reimbursement. We spend a lot of time, particularly with our client base independent practices from Long Island to the Hawaiian islands, across every conceivable clinical specialty and with practice sizes from one physician to several hundred scattered over 15 States.

When we see healthcare through lots of little individual knot holes in the fence, and to get a kind of a composite picture of what we see happening around the country. What’s working, what’s not working. And I have the best job of all, and I no longer have to worry about billable hours as a consultant.

I just get to come along and help my clients get to where they want to go. And they pay the invoice for our team doing the work, and I’m just sort of thrown in for free. So it’s the best gig imaginable. 

DP: Fantastic. Fantastic. So let’s, let’s start from the beginning. Where were you born? 

TC: Born in Fort Smith, Arkansas, right on the Arkansas/Oklahoma border.

I was, on the farm for a bit. I can’t say that I was a farmer, but I was raised by farmers. And so a lot of that, uh, put your head down and work, uh, values, uh, not only in my DNA, but, uh, uh, in how I was raised. So come from small town America, where we did not have a stoplight and were totally excited my senior year in high school, when we finally got a Sonic restaurant, our first chain of any sort. 

DP: So what was a typical day, growing up on a farm for you? 

TC: You know, we left the farm when I was pretty young, but one of my memories, um, was I was assigned to count the cows on the way home. We lived about five miles out of town. Um, Took me a long time to figure out that was actually not a very important job. It was just a way to keep me quiet and from asking so many questions. I was assigned to count hay bales one day and then got fired because I told them, I thought I’d lost count. We needed to unload the barn and put them back in again so I could get the count right. So, uh, my, my days as a hay counter were limited. And ended up moving and you know, my dad was a school teacher after he left the farm and I had the prototypical Norman Rockwell, small town experience. You know, nobody locked their door and left the keys in the car. The kids would get on their bike at sunrise, and as long as you were home by dark, nobody knew or cared where you were, but you better behave because the grapevine, the Mom connection, anything you did would beat you home.

Um, so it was just, you know, a perfect small town America growing up experience for sure. 

DP: I can  identify with that because, I’m from Boston and New York city, but I married a girl from a small town and, uh, and we’re raising our family. It’s a small town in Illinois, about 5,000 people. And, it’s exactly as you described it. SHe grew up where we do not lock the doors in the house.

And you know, again from Boston, New York, like, no, you absolutely. Now we, we kind of, um, argue over leaving keys in the car in our driveway. I’m like, why would you do that in the first place? But that’s tough. That’s a place where we’re raising our kids. Yeah, I think it’s a great place. 

TC: Look, I love being in Denver and in Colorado and, um, but wouldn’t trade anything in the world for where I grew up and what was instilled in me, you know from family and church and school and coaches. And again, right out of central casting for small towns. 

DP: So then what were some of your interests in high school? 

Tim Coan: I wanted to be an athlete and had to come to grips with the fact that I had no talent. Um, in fact, I went back to speak at a sports banquet once and my coach was introducing me, and what was a compliment turned into a really awkward moment when he went on and on and on about not just how hard I had worked, but I had to work hard because I was slow. I was short. I couldn’t shoot. And so ended up ironically with my first real experience with healthcare, I tore my meniscus in a bizarre fishing accident.

I think I’m the only person in America that has had multiple knee surgeries because of fishing. Um, and you know, in that timeframe I realized if I would apply the same level of effort to things where I might’ve been given a handful of gifts, uh, I could, uh, Maybe do something with my life and got involved in speech and debate and student government and carried that on to college.

And, um, it, it did turn out that, uh, talking for a living, I was. Better suited to do that, then, uh, anything that involved a speed or excessive hand-eye coordination. 

DP: So what was your first real job out of college? 

TC: Out of college um, you know, this is what got me into healthcare and it was a complete and total accident.

Um, my graduate work was in industrial organizational psychology. Um, I began my career as a change management guy, dealing with leadership and organizational culture. And I was at the university of Tulsa and got a call from the guy who ran our program, who said, Hey, do you yet have your internship that you need to graduate?

I said, no, I’m still looking. And. He said, well, if you can be at St. John hospital in 30 minutes, the vice president of human resources is looking for an intern. And so I’d been mowing and, uh, hopped in the shower, and began to think healthcare. I, I was in the hospital and I had my tonsils taken out when I was five. That was probably all I knew, um, and drove down and landed this internship where the hospital was looking for  someone to take on their EEOC cases They historically used lawyers and decided that was too expensive. So they had begun just paying settlements, but word had gotten out that Hey, if you get fired, just go down to the Oklahoma human rights commission, fill out a sheet of paper in the hospital, give you a thousand bucks to go away.

So now they had this big backlog of cases that, um, were. They can’t figure out what to do. So they got the bright idea of hiring an intern. So here I am like a 22 year old white guy from small town America on a Friday afternoon interviewing for an internship. And I get told that Monday morning at 10 o’clock, I will, by myself, represent the hospital in a hearing at the Oklahoma human rights commission.

I got handed a pamphlet and the only instructions were just don’t sign anything. And so, uh, I began my work in healthcare, uh, and it turns out to actually be from, from a leadership and organizational culture standpoint. And it turned out to be pretty good because when you get to, uh, someone filing a human rights case, whether it was valid or frivolous, you’re sort of starting with where things went wrong, uh, from a leadership standpoint.

And as I dug into, I think I had 18 cases over the course of a year. Um, you know, looking at files and interviewing managers and trying to figure out, you know, why did this former employee believe we had violated their rights and what was the right thing to do. And so I had all this academic training around organizational culture and leadership, and then I showed up sort of at the scene of the car crashes, to say what happened and why, and that actually, as it had literally no more advanced planning for my career than what I just shared, but it turned out to be a great launching point. And then I began to move. Backup stream, uh, ended up staying after the internship at the hospital.

Uh, as you mentioned, I, I met my lovely wife of 33 years there who was a neonatal intensive care nurse, but I began my consulting career there because I just started wandering around and, working with various administrators who had leadership or cultural issues, on their teams, and said, okay, we don’t want to end up with the mess that you just helped me get out of. What do we need to do to sort of stay out of that situation? So turned out to be, uh, again, uh, sometimes it’s better to be lucky than good. 

DP: Yeah. So there’s a luck aspect of it, but also there is your life experience has prepared you for that moment. So how do you, as somebody in your twenties, you know, come up with the ability to what has helped you provide that value to your hospital leadership when they say, Hey, we don’t want to find ourselves in that mess? 

TC: You know, I was always given some of it is his DNA, but it was really encouraged by my parents and some important people in my life, to just be intellectually curious and. Uh, yeah, I’ve walked into these situations where, I mean, I didn’t even know what the Oklahoma human rights commission was, that Monday morning and just began to read everything I could get my hands on, began to dig into the files, begin to talk to people. And you know, that, that helped me work through some of those early cases. You know, I had to go to administration was recommendation on, you know, what’s the right and fair thing to do here. But then as I began to move from those individual cases to a, vice-president saying, Hey, I’ve got a director here, I think there’s a lot of talent, but I’m hearing a lot of employee feedback. We’ve had a lot of turnover. Can you help me figure out what’s going on? And that notion of just starting to ask good questions and try to follow, you know, where does the question lead? Can you find some more information? And then, you know, I ended up for several years being a consultant at Anderson consulting, you know, before  it became Accenture. And then, on my own doing health care strategy during the Clinton health plan, right? The first time we put, hospitals together and physicians began to be employed by hospitals. And so if it was anything, Dave was just that idea of a good question that gets followed through is a lot better than knowing the answer.

DP: Right. That intellectual curiosity as surgery. Well, so along your journey, then what are some of the challenges that you’ve faced that you were truly stumped or something that you’ve observed, um, that say, you know what I got to learn from this? 

TC: You know, it’s interesting. Um, and this is, I think one of the reasons I’ve stayed in healthcare now for all these years. Some of our deepest, most intractable challenges that we’ve been trying to solve for a long time, are just that, you know, you just, you stare at the problem and you come to understand, and here’s the various players. Here’s what their incentives and dynamics are. Here’s the power of the status quo. Here are all the things that. Have to be traded off to try to move toward a better solution and you can understand the problem. Um, and sometimes it’s been really, really frustrating at our inability to make progress. You know, as we sit here and talk today, you know, the news just came out that the Haven joint venture, uh, is closing up.

And I, you know, I remember when this thing first came out, you had JP Morgan and Amazon and Berkshire Hathaway, and they’re going to change healthcare. And I was having a conversation with a client at the time and we were like, I wouldn’t bet on it. And, you know, and it turns out that they ran into some of the same challenges that a lot of other people have found in healthcare that, um, there are some big intractable things.

Now, the thing that has intrigued me though, is it is so big and so complicated and so important. And the thing I like about being in the independent physician practice space, as opposed to working with big payers or large hospital systems is we have a lot of clients that are not trying to boil the ocean of healthcare.

Uh, they are in their local market, they have their patients, they have their business. There’s very scrappy entrepreneurs who happen to be in the business of providing care that are trying to figure out, hey, how do I move the needle in my little corner of the universe? And so. I find that it, it is very invigorating watching what an OB practice in one part of the country is trying to do and how that might apply to a general surgery practice in another part of the country, that if enough of these small experiments, that improve quality and  lower cost can add up, that’s probably how we’re going to change this thing. I’ve just personally got, maybe it, maybe it’s the small town roots. I’ve got a lot more competence in a whole bunch of smaller agile folks doing what they’re doing then, some magic dictate from on high that. Is going to solve this thing that we’ve been trying to solve.

Again, I got started back in the Clinton health plan, you know, the first time that at least in my lifetime, there was really a lot of public willingness in the election of president Clinton to try to tackle this at a policy level. And we didn’t make a lot of progress. And president Obama got elected with a clear mandate.

And if you look at the numbers, I can’t see that we’ve made a lot of progress, but I can see some of the stories on the ground that our clients are doing. And it’s like, yeah, they’re improving the quality of care for Americans and that encourages me.

DP: Yeah, it’s just interesting. Cause you’re saying, you know, there are elements of, you know, not, not the big giants, um, but more of the, the local, the more agile organizations who may be able to come up with some best practices that work in one market that can be applied in another market.

So I do want to get back to that, but from a larger perspective yeah. When I read that Haven closed down, um, yeah, I read that essentially everybody had their motives, their own initiatives and they just couldn’t pursue that. From one perspective, people can argue, well, if JP Morgan and Berkshire and Amazon can’t figure this out, what hope do we have for this country? Like, how would you, how would you respond to that? 

TC: Well, and again, I will, I think those three inevitably, um, just had so much conflicting set of objectives and this is one of the reasons I’m, I’m never terribly optimistic, regardless of which party’s in charge, that this is a policy level answer, but I’ll respond by sharing one of my favorite anecdotes that we’ve been working on with one of our clients. So we’ve got a pain management group. They’re actually the largest, pain management group in the country. It’s still microscopically small by large healthcare standards and beginning back in, in a very aggressive way, three or four  years ago, they began to run straight at the opioid problem and you know, this, the picture that comes to my mind is, you know, the firefighters running into the building when everybody else is trying to run away. There were a lot of people that were petrified of the opioid problem, looking for finger pointing and this group of physicians, because they. Not only are probably the best trained of any specialty to manage a long-term patient on opioids, but they also have a whole range of alternative treatments that are non-narcotic and watching them come together as a group of about now 200 providers up and down the East coast, sharing their clinical data, talking hard to themselves about what works and what doesn’t work. We’ve looked at the data with them over the last couple of years, they have dramatically reduced the number of patients on opioids. They have taken patients that are still on opioids. 

DP: How did they do that? You have over 200 providers, how do they get together and decide to do something for the collective good as opposed to their own self-interests?

TC: Well, the Great thing about this group. There, there were seriously, it’s a private equity backed deal that they brought a bunch of, uh, practices together, but they really. But the management function on the business side, but the clinicians really do run the clinical side of the business.

It is a physician led organization in every sense of the term. The CEO is a practicing pain management physician that just happens to have a great business mind. And so this was bringing data out of their EMR. We did a lot of work to help them pull their data together. The claims data that we have again in the plumbing part of their business was really rich and put that back in the hands of physicians and they began to talk about clinical protocols.

They began to talk about risk factors that would say, Hey, here’s a patient. That, uh, we can move. Maybe we can’t get them totally off of opioids, but we can move them from a, high intensity, high risk, large, morphine equivalent med to a lower morphine, uh, equivalent med, and reduce the risk of a bad outcome.

We can move these patients through some of their, non-surgical interventions, off of opioids  entirely. Dave, it was, I mean, we got to sort of set on the front row of the bleachers and watch cause we were providing some data. I got to participate strategically, but it was just as organic as what we were talking about before.

It was, um, no big central committee, uh, no dictate from on high, but hands-on physicians talking to one another, she shared what she did. He would share what he did and. Their data just began to trend in the right direction. And they have literally pulled millions of unnecessary pills off the street.

They’ve dramatically reduced the risk of adverse exposure from teenagers, getting a hold of. You know, meds and the med cabinet, they have gotten people back to work. And so, again, that is a story I could tell you a story about what a, one of our pediatric groups is doing with the integration of mental health, uh, into the pediatric practice.

But again, what I take away from that is we get all caught up in the headlines. Um, but there’s stuff on the ground happening with healthcare providers that are just. For to take in what they learn. They want to take care of their patients.  They talk to one another, especially now that some of the technology lets us get them data, more effectively, that will facilitate some of those conversations.

Um, and. I just have a lot of confidence that, that model, it might not be the only part of our long-term answer, but it’s a real central point. 

DP: Strong leadership. Like didn’t you just, you mentioned a physician CEO, strong leadership. Clinically-driven data that helped provide the insights for the business operations and also for the better outcomes for the patients. Right. I’ve also kind of heard of stories where, you know, there are leaders who have data. Strong outcomes yet. There’s still, you know, the old adage, no one ever got fired by buying IBM. That still exists in healthcare. So how does it work? How do we transform that? How do we get the leaders to, how do we transform that?

TC: Well, this is where we come back to some of the bigger intractable problems. I feel like something of the armchair self-taught economist, right? Because while Oh, physicians. And, and, you know, I’ve been talking and working with docs now for a long time. Um, most of them really do want to do the right thing for their patients.

There, there are some bad Apple positions, just like there are bad apples everywhere, but, um, on the other hand, um, they are very entrepreneurial. And, uh, they do respond, you know, to financial reimbursements. So the place that I think there is an opportunity to, uh, bring a lever to the transformation process is as we change how things get paid. The problem is at the physician level. If we look at a lot of what’s happened coming out of Obamacare with the creation of large integrated delivery systems that are now partnered with large payers, there’s a version of value-based care. It gets trumpeted alive, particularly by CMS and how many dollars they’re paying on value-based care.

When you really get down to it, it is aimed at hospitals and the hospital employed physicians and that part of the market. We’ve not made great progress with the possible exception of Medicare advantage and some managed Medicaid plans of getting independent physicians into a value-based world. Um, now where I am most optimistic and again, some of our clients are having some of these conversations is not so much about the payers.

I believe the payers are responding to their own incentives and, and they’ve got a lot of reason to protect parts of the status quo, but as employers get more active and saying, Hey, this is a big part of our spend and there’s no reason we shouldn’t manage it the same way we manage the rest of our supply chain.

I think it’s a little bit of maybe the Haven story, you know, as you read between the lines, Amazon said, Hey, look as the payer of healthcare, we’re managing this ourselves. We’re taking our own tips. I think the most disruptive company in healthcare right now, and I say this as a proud boy from Arkansas, is Walmart, right?

So as employers start to get more active into the process and not passively say, Hey, we awarded the contract to one of the big payers. They’ll take care of it. What we’re encouraging, innovative, independent physicians, particularly some that have gotten a little bit of size and scale is who you want to talk to as the employer, because the employer directly and on behalf of their employees is, is the headwaters of paying the bill and they get a lot more innovative. And so conversations around direct contracting, bundled payments for certain types of surgeries. I mean, I’ve talked to a 12 doc orthopedic group the other day. This is not a big company.

It’s big as an orthopedic surgery practice, relatively speaking to this tiny company, they own their own surgery centers and they are. Partnering with some local employers in town to give them bundled pricing with surgery facility, anesthesia, postoperative PT on a handful of orthopedic cases. Many of them are sort of taken from some of the CMS models and they are dramatically reducing the employer’s cost.

The employees cost and delivering a more integrated, higher quality of care. Now that is a tiny microscopic example of one practice with one set of employers in one small Midwestern town. But those kinds of things are happening all over the place. And so our message to, to the docs is, yeah, the, the rules of the game are tilted against you.

They really do favor the Titanic, big organizations, um, like CMS, like United, like Ascension, but, um, You have a massive advantage on agility, you have a massive advantage on the patient relationship. You are the ones that make decisions at the point of care with the patients that sort of set in motion, what will happen clinically and what will, what the cost will be.

That’s where we think there’s a great opportunity. And as those conversations began to occur, with the ultimate payers, the employers and the individuals, we’re seeing some pretty interesting, innovative things happen. 

DP: Are you beginning to see a lot more of those employers going after the, just having conversations with the independent physician groups, because the industry trend is private equity firms just buying out. Well, let me just, it’s just the whole idea of this health systems buying a physician practice, right? One of my good friends is an orthopedic surgeon and they just got bought out by a private equity group and, you know, so. That’s happening. So how do physician groups get at the table when there’s like, no, we’re only going to work with this large health system in our area?

TC: Well, the interesting thing, and I sat right in the middle of that, uh, health system versus, evil, private equity– I have clients on both sides of that. If you step back, it is inevitable that the days of the really small physician practice, the one to five providers are going to have a hard time.

They’re gonna have a hard time, uh, getting to the table with a conversation with a large employer, they’re going to have a hard time investing in the management talent necessary to lead these things. They’ll have a hard time buying the technology or the data analyst. So size and scale matters. So now the question is who’s the right consolidator of these physician practices? And again, because I cut my teeth helping health systems buy physician practices in the nineties, that model was there, then it got unwound and now it’s back again. Um, and in certain context it makes a lot of sense. There really is an integration of care. The problem is, the data is just now overwhelming, and you look at CMS in particular, starting to push back. The net effect of all the integration on the health system side has been to increase, not decrease our costs. We have large health systems that now have monopoly, negotiating leverage. Um, I mean, here in Colorado, one of our health systems I think is one of the most expensive in the country because of their negotiating leverage.

The second problem is the way our reimbursement model works today. Uh, take a primary care physician, that was independent. They get bought by their hospital system tomorrow and that bill becomes more expensive, right? Nothing changed. The clinical capabilities, the same, the doctor’s the same, but because of the employment status, the Bill’s more expensive.

So while that model. Again, makes sense in certain contexts, it is clearly not proven to be the savior that maybe 10, 12 years ago, when we first kicked up this iteration of both policy and market reform, we thought. Conversely along comes private equity. And again, there are plenty of concerns with that model, but the physicians remain independent and, and they don’t become employed by the hospital, the next surgery center. Yes. It’s owned by the physicians that it’s owned by equity. And some people somehow, uh, have, uh, some kind of problem that a profit motive is problematic, but I, I struggle to see the challenge if that facility, which pays a distribution to its owners still delivers the same quality care at a 30% discount on the cost why that’s a bad thing. And so clearly, you know, I’m a market oriented guy, but I think there’s a role for equity. We’ve seen some go really, really well, where the equity sponsors, bring management talent, bring the capital to get to scale and drive a high value. And, you know, we’ve seen some other situations that did not go well for anybody involved. But I think the same is true on the health system side. 

DP: So tell us the Story about how ALN medical management is transforming healthcare in your world? 

TC: Well, it’s interesting. Like I said, we’re plumbers, right? I personally spend a lot of time with our clients on the strategic stuff, but our business, we give, we get paid to turn a doctor’s claims into cash. We’ve got the same need for scale and technology in that part of the business, as we do everything else. When we first got started, the billing business was fundamentally a staffing business, right? Um, almost all the cost and billing, whether a practice did it in-house or with a third party where humans and it was just a discussion as to do they sit on your payroll or mine.

Now as we slowly begin to catch up with the rest of the financial services industry, these are increasingly technology enabled financial transactions. Exceedingly complex financial transactions, right? Processing a vascular surgery claim with three CPT codes is not quite the same as an ATM transfer, but it is a financial transaction.

So now we have the scale we’re currently processing in the neighborhood of 250,000 claims a month on behalf of our clients. So we can invest in technology that continues to automate that process and reduce the cost, because the cost of getting a position paid is some level of friction in the system. Right. It’s not directly making a patient well, but it’s a cost of doing business. So our industry has probably seen a 40% reduction in that cost on a per transaction basis, over the course of our 20 years of being involved in the business. And that really is again, our ability to invest. On behalf of our clients in building claims processing data analytics capabilities that they essentially rent and piggyback on so less of their money goes to pay for Administrative service and a more can go into taking care of their patients. 

DP: So, our listeners are leaders in acute as well as post-acute care. And in light of COVID, there’s been a lot of available reimbursement codes that came out. What insights could you share with our acute audience, as well as your post-acute audience in terms of what they should think about or should be aware of in terms of claims or data analytics?

TC: Yeah, well, one of our very specific, COVID related observations and it’s been the topic of a lot of discussion is what happened with telehealth. Telehealth had long been a floundering technology from an adoption standpoint that I think for those of us, the industry didn’t make a lot of sense other than the fact that the status quo and rules of the game favored.

Not adopting it. COVID comes along and we see this massive spike in telehealth. It was interesting. We looked at our composite client data every day through COVID just like everybody else did. We looked at total visits and we broke out telehealth and our data from. Our positions on the ground match some of the big headlines.

There was a massive spike. Some of our practices did a much better job standing up to telehealth in some of our specialties are far more suited to it, right? Um, you can do a certain well visit with adults. Be via telehealth easier than a pediatrician can assess a two month old.

We’ve now seen that come way off its peak though. It’s now at a new normal. We’re seeing many of our practices that had virtually no telehealth prior to COVID that they believe will probably settle in at about 10% of their, nonsurgical volume that will stay telehealth forever. So bigger than virtually zero, but not the 30% that we saw for a period of time.

I think the opportunity when, if I were setting in a particularly a large health system and we had employed a lot of primary care practices, the question is I think the winners in the telehealth space now that the geography of my doctor and I becomes irrelevant, is it’s really easy to set up video conferencing and say, I’m in the tele-health business.

Just like it’s really easy to stand up a website on Etsy and say, I’m in e-commerce and I’m selling my brownies or whatever, but some people are actually now reinventing the patient experience in a way that takes advantage of that platform. It’s not just, we’re going to do the same thing you used to do in the office, but we’re going to do it instead on this, uh, herky jerky video conference.

But they’re rethinking if this is totally enabled by technology and geographically distant. What would we do different? And I think the opportunity, particularly for some large players in, in big health systems, they have a lot of providers and a lot of talent on the technology side and on the patient experience side is the ones that rethink that,  just like we’ve seen in the e-commerce world, right? The people that really rethought e-commerce and didn’t just try to do an online, simulation of the store. Consumers have now tasted this and they’re now going to demand it in certain situations, but they’re good at demand. Good telehealth um, they tolerated whatever. In the spring and early summer of 2020, but I believe as those expectations have now changed, they will shop for a good telehealth experience. Just like they shop or a good online groceries. 

DP: As we wrap up the podcast, I want you to just fill in this blank. So right now, Tim, you are the CEO and you have a platform where you’re leading 150 employees. You have over 500 providers. So 10 years from now, I will have made healthcare blank. 

TC: You know, our mission is to enable independent practices to control their destiny. I believe at a really deep level, that the United States healthcare system, by definition, the nature of healthcare, we need really, really large institutes. We need the government involvement because healthcare costs are not evenly distributed nor are economics. So we’re never going to go to a place that we leave people on their own. We’re always going to take care of people who get hit hard and the government’s role in economically making that happen makes sense.

We need large pharmaceutical companies that can invest like Kaiser did and the vaccine. We need large hospital systems. We need large insurers. Those are all really, really capital intensive businesses. But, we deeply believe, and I personally believe that the extent to which we have a very robust thriving independent physician ecosystem that works in ,with, and around those large players to help translate their work to very personal, very individualized moments of care for a patient and their family. Our collective health care ecosystem will be better. So if five to 10 years from now, we’re able to point to practices that were our clients that remained independent, they partnered with other folks, but we’re able to carve out a very specific place on the care delivery architecture and serve those patients well. And so you guys have enabled us financially. You’ve enabled us from a technology standpoint, you’re enabled this from a data standpoint to do things like, you know, our pain group was doing around opioids, uh, too.

You know, try to eliminate bad out. If at the end of the day, I get to say, you know, we grabbed an oar and paddled hard on behalf of that part of the system. I’ll be happy. 

DP: Beautiful, beautiful. So essentially you’re the champion for these independent physicians who you help them control their own destiny and through partnership and through these clinical driven data that you guys help them to carve out their niche and just be the best.

At what you do there for the ultimate best outcomes for the patients. Yeah, that’s, that’s a beautiful feature. 

TC: And to close it and bring it full circle, that acute nurse that I met, you know, 34 years ago, is still a nurse. She’s currently a hospice nurse, frequently working in the COVID unit. And so while I am on the administrative and financial side, she comes home every day and tells me the story of a patient with a name and a family. And it’s a great reminder for me that while, you know, we’re in the boiler room somewhere you know, holding the shovel for the people that are doing the work at the end of the day, there are individual folks that have individual needs with individual families, and when they come in contact with their physician, our job is to make all the unnecessary financial and the administrative stuff fade into the background so that our great caregivers can do what they need to do in that moment. 

DP: That’s a great exhortation to our leaders. Um, so we’re always driven by data, but at the same time, these people’s lives, stories. It’s a great reminder for us to, you know, when we make that data-driven decision because we are, you know, trying to make their lives better. So that’s great. 

Lightning round. So, first word that pops into your mind. 

How would you describe your leadership style? 

TC: Challenging. 

DP: How would your friends describe you? 

TC: loud 

DP: who is your favorite hero in a story or in a movie? 

TC:  David from the Bible. David from Warren Haynes from the Bible, um, change the rules of the game, made it not about sword fighting and made it about slingshots.

Interesting story from Malcolm Gladwell. 

DP: Yeah. I did read that as a very interesting perspective and just some thought that, you know, Gladwell is saying that, Goliath may have been, uh, his eyesight may not have been great, so I’m like, I never felt that way as well. You’re right. So, yeah, I love that story.

What’s uh, how about this? What have you learned? What’s the key insight that you learned about yourself in 2020? 

TC: I’m an extrovert that needs to be out talking to people. Amen. Not just moves the English bulldog. 

DP: Final question. Any new year’s resolution? 

TC:  Yeah, I’m going to paint more. 

DP: Houses? Sceneries? What are we talking about? 

TC: No, down in my basement, I’ve got some canvases. Like my athletic career early, I have zero talent. So I do abstract impressionism, which means most of my canvases just have layers and layers of stuff that didn’t work, but it makes a very cheap hobby. If you just keep painting it over and over again.

DP: Finally, what life lesson would you like to share with the next generation? 

TC: I was actually thinking about this in another context. Today my kids would tell you–they’re all in their twenties–dad has raised them with a handful of bumper stickers that he repeats over and over again. And one of my favorites, came from the back of a program, at a bar mitzvah from a kid on my middle school football team. A Rabbinical saying that I stole. It says simply “be yourself to be your best self.”

We don’t need you to try to be anybody else, but all of us get to make a decision every day, whether we’re a good or better or worse version of ourselves. So be yourself, be your best self and right. 

DP: And we’re all running our own race. So just keep on striving toward the finish line, whether you have a Tim Coan.  A leader who is transforming healthcare by championing the independent physicians to do their best. Well, thank you very much for joining us today. Thanks. Really enjoyed the conversation. Likewise, Tim, thank you.


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